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Body Piercing
Let us do this part
Today's Date:
Thu Apr 9 2026 06:04
Practitioner:
*
-- Select --
Brogan
Piercing(s) being performed:
*
Please read and answer
Y
N
Blood Sugar
*
Have you eaten in the past 4hrs? If the answer is no, please alert the piercer and they will be able to provide you with a sugary snack and drink or you will be given time to leave the studio and return after eating.
It’s very important to have eaten so that your body’s blood sugar levels are high enough to deal with the shock from a piercing.
Y
N
Bloodbourne Pathogens
*
Do you have any bloodbourne pathogens, transmittable diseases or recent illnesses?
If so, please specify which.
(It’s absolutely fine if you do - we just need to know for our own safety and that of our clients).
Details:
Y
N
Medical Conditions
*
Are you pregnant or nursing?
Y
N
*
I agree I do not have diabetes, epilepsy, hemophilia, a heart condition, nor do I take blood thinning medication. I do not have any other condition that may interfere with the application or healing of the tattoo. I am not the recipient of an organ or bone marrow transplant or, if I am, I have taken the preventive anti-biotics. I am not pregnant or nursing. I do not have a mental impairment that may affect my judgment in getting the tattoo.
If any of the above do apply to me (tick no and specify which), I have sought the appropriate medical advice and approval prior to my appointment. I am also aware the tattoo process and healing can cause complications for any existing medical conditions I may have.
Details:
Risks
*
I have been fully informed of the risks, associated with getting a piercing.
I understand that these risks, known and unknown, can lead to injury, including but not limited to infection, scarring and keloiding and allergic reactions.
Having been informed of the potential risks associated with getting a piercing, I still wish to proceed with the piercing and I freely accept all risks that may arise from piercing.
Questions
*
I agree that both the piercer and the piercing studio have given me the full opportunity to ask any and all questions about the piercing procedure and the they have been answered to my total satisfaction.
Duress
*
I affirm that I am not under the influence of alcohol or drugs, and I am voluntarily getting a piercing without duress.
Permanent change
*
I understand that the piercing will result in a permanent change to my appearance and that my skin may not be restored to its pre-piercing condition even in the event of a removal.
Form
*
I acknowledge that I have been given adequate opportunity to read and understand this document, that it was not presented to me at the last minute, and I understand that I am signing a legal contract.
Jewellery
*
I understand that I am responsible for the upkeep of my jewellery, and that the studio is not responsible if I lose all or part of a piece of jewellery.
I agree that I will check my jewellery is securely tightened several times a day as advised by my piercer.
I affirm that if I remove my jewellery for any reason during the healing process, my piercing may close up and the piercer cannot guarantee re-fitting the jewellery for me.
I acknowledge that no refunds will be given if I remove or lose jewellery from my piercing.
Aftercare
*
I affirm that I have been given instructions on the care of my piercing during its healing, and I understand and will follow them.
I acknowledge that it is possible that the piercing can become infected, particularly if I do not follow the instructions.
I understand it is my sole responsibility to care for my piercing, and that if I do not follow proper aftercare as advised, I may need to remove my piercing to prevent excessive scarring or keloids.
Photography
*
I release all rights to any photographs taken of me and the piercing and give consent in advance to their reproduction in print or electronic form.
If any provision, section, subsection, clause or phrase of this release is found to be unenforceable or invalid, that portion shall be severed from this contract. The remainder of this contract will then be construed as though the unenforceable portion had never been contained in this document.
Client Information
I hereby declare that I am of legal age (with valid proof of age) and am competent to sign this Agreement or, if not, that my parent or legal guardian shall sign on my behalf, and that my parent or legal guardian is in complete understanding and concurrence with this agreement.
Legal Name:
*
Pronouns:
-select-
He/Him
She/Her
They/Them
He/Them
She/Them
He/She
He/She/They
Other
Chosen name:
Address:
*
Postcode:
*
Date of birth:
*
-Year-
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-Month-
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-Day-
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If you are under
16
your parent/guardian will be required
Age:
Phone #:
Email:
*
Signature:
*
Sign or type signature:
Parent/Legal Guardian
I, as custodial parent or legal guardian of the above minor under 16 years of age, hereby consent to the terms and conditions set forth in this release form and I attest that all documentation I have provided is true and accurate.
Legal Name:
*
Relationship:
*
-select-
Natural guardian (birth parent)
Legal parent via marriage
Legal guardian via adoption
Other (provide proof)
Signature:
*
Sign or type signature:
Photo Identification
Please take photo(s) of your government issued photo IDs and related paperwork
X